Impotence, Male

General Illness Information


Medical Term:

IMPOTENCE, MALE SEXUAL

(ERECTILE DYSFUNCTION)

Common Name: None Specified

Description:

  • A consistent inability to achieve or maintain an erection;
  • Impotence is not inevitable with aging. The capacity for erection is retained, though a man may need more stimulation to achieve erection and more time between erections than in the past.

Causes:

Psychological causes include:

  • Guilt feelings;
  • A poor relationship with the sexual partner;
  • Psychological disorders, including depression, anxiety and stress.

Physical causes include:

  • Diabetes mellitus;
  • Atherosclerosis (hardening of the arteries);
  • Use of some anti-hypertensive medications and antidepressants;
  • Disorders of the central nervous system, such as spinal-cord injury, multiple sclerosis, stroke or syphilis;
  • Endocrine disorders that involve the pituitary, thyroid, adrenal or sexual glands;
  • Alcoholism;
  • Drug abuse, especially of marijuana, cocaine, narcotics, tranquilizers, sedatives, hypnotics and hallucinogens;
  • Decreased circulation to the penis from any cause.

Prevention:

  • Maintain good communication with your partner. Don’t be hesitant about discussing the problem, exploring your needs and asking for help. Your partner’s understanding is critical to solving the problem;
  • Don’t drink more than 1 or 2 alcoholic drinks, if any, a day. Don’t use other drugs that can be abused;
  • If you have diabetes, adhere closely to your treatment program;
  • Maintain overall good health;
  • If any new medication you take changes your sexual function, discuss this with your doctor. A change in medication may be all that is needed;
  • Regular exercise.

Signs & Symptoms

  • Inability to achieve an erection;
  • Inability to maintain an erection for the normal duration of intercourse (erection may be too weak, too brief).

Risk Factors

  • Same as problems listed in Causes;
  • Recent illness that has lowered strength;
  • Recent major surgery, especially prostate surgery.

Diagnosis & Treatment

Medical tests as needed for diagnosis of any underlying disorder. Physical causes must be ruled out by appropriate testing. Diagnostic tests may be done at a special center to measure nocturnal erections.

General Measures:

  • Psychotherapy or counseling (alone or with your partner) from a qualified, professional sex therapist;
  • If medication is the cause, a change in medication or changes in dosage amounts may be helpful;
  • Self-administered penile injection therapy may be prescribed;
  • Use of vacuum erectile device may be recommended for some patients;
  • Surgery to implant an inflatable or non-inflatable penile prosthesis.

Medications:

  • Medication may be prescribed to treat the underlying medical condition;
  • If hypogonadism present, testosterone cypionate 200 mg IM every two weeks;
  • If hyperprolactinemia present, bromocriptine 2.5 mg bid up to 40 mg/day.

To induce erection:

  • Intracavernous injection of a solution containing phentolamine 0.5-1.0 mg and papaverine 30 mg per mL, starting with 0.1 mL;
  • Alprostadil (Caverject) 10-20 mg/mL; inject into the dorsolateral aspect of proximal third of the penis. Do not exceed 60 mg dose. Do not use more than 3 times a week or more than once in 24 hours. Patient to notify physician if erection lasts > 6 hours for immediate attention;
  • Alprostadil (Muse) urethral suppository 125 mg, 250 mg, 500 mg, and 1000 mg pellets. Maximum of 2 uses in 24 hours;
  • Sildenafil (Viagra) 50 mg 1 hr before desired erection. May be effective in 30 minutes and up to 4 hours after dosage. Older patients or those with renal or hepatic disease need half the dose of others to achieve similar blood levels. Side effects: headache, flushing, indigestion, visual changes;
  • Recently there has been renewed interest in herbal therapy for impotence. Ginkgo biloba in particular, has been considered to be helpful, especially in impotence and low libido caused by anti-hypertensives and anti-depressants. It has also been shown to be helpful in cases of lack of libido in women.

Activity:

No restrictions.

Diet:

Eat a well-balanced diet.

Possible Complications:

  • Depression and loss of self-esteem;
  • Marital problems or breakdown of close personal relationships.

Prognosis

  • For cases with physical origins, treatment of the underlying disorder or changes in a medication therapy may improve sexual performance;
  • Spontaneous recovery or recovery after brief counseling in many cases with psychological origins;
  • Other medical methods to improve erectile function have greatly improved the outlook.

Other

Nothing Specified.

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